Gregory S. Dedrick

Chronic female pelvic pain--part 1: clinical pathoanatomy and examination of the pelvic region.

Abstract:  Chronic pelvic pain is defined as the presence of pain in the pelvic girdle region for over a 6‐month period and can arise from the gynecologic, urologic, gastrointestinal, and musculoskeletal systems. As 15% of women experience pelvic pain at some time in their lives with yearly direct medical costs estimated at

The Deep Neck Flexor Endurance Test: Normative Data Scores in Healthy Adults

2.8 billion, effective evaluation and management strategies of this condition are necessary. This merits a thorough discussion of a systematic approach to the evaluation of chronic pelvic pain conditions, including a careful history‐taking and clinical examination. The challenge of accurately diagnosing chronic pelvic pain resides in the degree of peripheral and central sensitization of the nervous system associated with the chronicity of the symptoms, as well as the potential influence of the affective and biopsychosocial factors on symptom development as persistence. Once the musculoskeletal origin of the symptoms is identified, a clinical examination schema that is based on the location of primary onset of symptoms (lumbosacral, coccygeal, sacroiliac, pelvic floor, groin or abdominal region) can be followed to establish a basis for managing the specific pain generator(s) and manage tissue dysfunction.

Changes in Transversus Abdominis Thickness With Use of the Abdominal Drawing-In Maneuver During a Functional Task

To investigate (1) the average hold time for the deep neck flexors (DNF) endurance test in subjects without neck pain or pathology, and (2) whether different groups of subjects categorized by age, gender, and lifestyle display different hold times.

Changes in spinal height following sustained lumbar flexion and extension postures: a clinical measure of intervertebral disc hydration using stadiometry.

The purpose of this study was to examine an individuals ability to produce an increase in transversus abdominis (TrA) thickness during the performance of a functional task with the use of the abdominal drawing‐in maneuver (ADIM).

Change in spine height measurements following sustained mid-range and end-range flexion of the lumbar spine

BACKGROUND Decreased intervertebral disc height can result in diminished load carrying capacity of the spinal segment. Clinical means of assessing postures able to rehydrate the discs were investigated. OBJECTIVE The purposes of this study were 3-fold: (1) to determine if our test protocol using a commercially available stadiometer demonstrated findings consistent with prior laboratory-based protocols; (2) to determine if hyperextension in the prone position and trunk flexion in the supine position caused increased spine height after sustained loading; and (3) to compare the effects of hyperextension in the prone position and trunk flexion in the supine position on spine height changes after a period of sustained loading. METHODS This study used a pretest, posttest crossover design. Ten women and 11 men (mean age, 24 +/- 2.6 years) participated. Subjects held either 10 minutes of hyperextension in the prone position or 10 minutes of trunk flexion in the supine position in the recovery phase. Spine height was measured using a commercially available stadiometer. Spinal height change was determined from measurements taken after loaded sitting and measurements taken after hyperextension in the prone position and trunk flexion in the supine position. RESULTS A 1-sample t test indicated no significant difference existed between our mean height change after 5 minutes of sitting and previously published validated findings. A paired t test indicated significant increase in height after both supine flexion and prone extension lying (P< .0001). The mean height gain was 3.11 mm using prone extension and 3.19 mm using the supine flexion protocol. A paired t test indicated no significant difference between these 2 recovery positions (P = .927). CONCLUSION The stadiometer measurement protocol demonstrated that hyperextension in the prone position and trunk flexion in the supine position were easily effective positions for the temporary recovery of spine height after sustained loading. These findings lay the foundation for future research into the viscoelastic creep properties of the intervertebral disk under loading and therapeutic conditions.

The effect of isometric shoulder internal and external rotation on the acromiohumeral distance.

Workers lose height during the day. Flexion-based exercises and body positions are commonly prescribed to unload the spine and prevent back pain. Lumbar extension positions have been researched and result in an increase in spine height. End-range lumbar extension postures increase spine height to a greater extent than mid-range lumbar extension postures, but these positions are not always tolerated by patients with lumbar conditions. No study to date has investigated the effect of end-range versus mid-range lumbar flexion postures on spine height changes. The purpose of this study was to investigate the effects of two techniques commonly used in clinical settings to unload the lumbar intervertebral disc (IVD) segments through increasing spine height in: (1) a sidelying mid-range lumbar flexion position; and (2) a sidelying end-range lumbar flexion position. A total of 20 asymptomatic women and 21 asymptomatic men with a mean age of 23.8 years (±2.5) participated in the study. Subjects were randomized systematically into 2 groups to determine the order of testing position. Measurements were taken with a stadiometer in the sitting position to detect change in spine height after each position. Results of the paired t-tests indicated that compared to the spine height in sitting, the sidelying end-range lumbar flexion position resulted in a statistically significant (p < .001) mean spine height gain of 4.78 mm (±4.01) while the sidelying mid-range lumbar flexion position resulted in a statistically significant (p < .001) mean spine height gain of 5.84 mm (±4.4). No significant difference between the height changes observed following the two sidelying positions was found (p = .22). Sidelying lumbar flexion positions offer valuable alternatives to lumbar extension positions to increase spine height, possibly through increasing hydration levels of the lumbar IVD and could be proposed as techniques to offset spinal shrinkage and the biomechanical consequences of sustained loads.

Association of disturbances in the thoracic outlet in subjects with carpal tunnel syndrome: a case-control study.

Objective This study aimed to determine the effect of isometric internal and external rotation at various degrees of shoulder abduction on the acromiohumeral distance (AHD). Design This was a prospective study that used a within-subject repeated-measures design and randomization of independent variables. Data from 29 of 58 (40 women, 18 men) prospectively enrolled healthy subjects were used for analysis. A still ultrasound image of the right subacromial space was taken to measure the AHD for each of three contraction conditions (rest, isometric internal, and external rotation) at three shoulder positions (neutral and 30 and 45 degrees of abduction). Results Intrarater reliability ranged from 0.86 to 0.99. At 45 degrees of shoulder abduction, the AHD was significantly smaller with isometric external rotation when compared with no contraction (P = 0.0015) and with isometric internal rotation (P = 0.0002). Conclusions The AHD was not affected by resistive isometric internal rotation of the shoulder, although it decreased with resistive isometric external rotation at 45 degrees of shoulder abduction. Resistive isometric shoulder external rotation in a position of abduction should be used with caution when the goal is to maintain the AHD. Further research is required to determine the effects of isometric contraction in patients with subacromial impingement syndrome.

Immediate Changes in Spinal Height and Pain After Aquatic Vertical Traction in Patients With Persistent Low Back Symptoms: A Crossover Clinical Trial

INTRODUCTION A limited amount of research has investigated the potential relationship between carpal tunnel syndrome (CTS) and thoracic outlet dysfunction. PURPOSE OF THE STUDY To compare the prevalence of positive clinical tests suggestive of disputed neurogenic thoracic outlet syndrome (TOS) in subjects with CTS (CTS+) with that of subjects without CTS (control). STUDY DESIGN Case-control study. METHODS Subjects with electrodiagnostically confirmed CTS (CTS+) were recruited consecutively and matched by age (±2 years) and gender with asymptomatic (control) subjects. Subjects underwent clinical testing for neurogenic TOS using two provocative tests: modified Cyriax release test and elevated arm stress test (EAST). Subjects were tested for the presence of an elevated first rib using cervical rotation lateral flexion (CRLF) test. RESULTS A total of 32 investigational subjects and 32 matched control subjects was included in each group (mean age: 43.5+5.9 years). A significantly greater number of CTS+ subjects presented with positive provocative testing for TOS (modified Cyriax release test p=0.005; EAST approached significance p=0.027) and for the presence of an elevated first rib (CRLF test p=0.003) as compared with controls. The likelihood of neck pain, shoulder pain, or an elevated first rib was 16 times greater in the CTS+ group as compared with that in the control group. CONCLUSIONS A greater number of subjects with CTS presented with proximal dysfunctions suggestive of TOS and history of neck and shoulder pain. Evaluation of proximal structures involved with thoracic outlet dysfunction in persons with CTS has clinical merit. LEVEL OF EVIDENCE Level III-b.

Immunohistochemical and histological study of human uncovertebral joints: a preliminary investigation.

To investigate the effect of aquatic vertical traction on spinal height, pain intensity, and centralization response compared with a land‐based supine flexion position for patients with low back pain and signs of nerve root compression.

Reliability of a seated three-dimensional passive intervertebral motion test for mobility, end-feel, and pain provocation in patients with cervicalgia

Study Design. A descriptive cadaveric study. Objective. To investigate the anatomy and innervation of the uncovertebral joint to determine if it is synovial in nature and capable of generating pain. Summary of Background Data. There is controversy with regard to the anatomic and histological makeup of the uncovertebral interface with some authors considering it a joint and others disc tissue. No research has investigated the presence of pain generating neurotransmitters within the uncovertebral cartilaginous and capsular tissue. Methods. Tissue from uncovertebral capsule and cartilage was harvested for each uncovertebral surface starting at the C2–C3 to the C6–C7 cervical segment. The tissue was placed in 4% paraformaldehyde fixative, then dehydrated and embedded in paraffin. Ten micron sections were cut through the tissue blocks and mounted on slides. The tissue was rehydrated and either stained with hematoxylin and eosin (H and E) or immunostained with antisera against protein gene product 9.5 (PGP 9.5), substance P (SP), neuropeptide Y (NPY), and calcitonin gene-related peptide (CGRP). Results. The sample consisted of 2 unembalmed fresh male human cadavers of a mean age of 83 years. Chondrocytes and synoviocytes were identified at the capsular tissue of each uncovertebral interface from C2–C3–C6–C7. Immunoreactivity for PGP 9.5, SP, CGRP, and NPY was observed at all uncovertebral interface levels in capsular tissue. Conclusion. The presence of both synoviocytes and chondrocytes has been recorded in the present study, suggesting that the uncovertebral interface is synovial in nature. Immunoreactivity to PGP 9.5, SP, CGRP, and NPY indicates the presence of nerve fibers from both the somatic and autonomic nervous systems. These findings suggest that the uncovertebral joints are potential pain generators in the cervical spine.